The invention relates to accessory devices for laparoscopic operations for use in combination with a plastic receptacle serving to receive tissue fragments that are to be removed by laparoscopic means, for intra-abdominal protected intermediate storage.
Connection elements for devices of this kind have been known from the publication Laparoscopic Nephrectomy: Initial Case Report, The Journal of Urology, Vol. 146, 278-282 August 1991.
In the case of laparoscopic operations performed through small openings in the abdominal wall, the extraction of organs, parts of an organ or of calculi may be difficult or even impossible without additional measures, and may be connected with additional risks for the patient.
During the operation, removed, intact, non-infective organ tissue usually is stored in the free abdominal space. This is, however, connected with the risk that the tissue may not be found again later. If intra-abdominal transmission of terms, or loss of organ fragments or calculi is to be feared, one must proceed to the extraction immediately, and this may complicate the operation or considerably extend its duration.
A suitable plastic receptacle placed inside the abdominal space may serve to receive the removed contaminated tissue fragments in the manner of an intermediate storage in order to avoid the before-mentioned disadvantages.
Intact organ tissue usually is removed through the umbilical incision. This presents no problems when the tissue, after having been pulled into the trocar sleeve, can be removed together with the latter. In most of the cases, however, the trocar diameter is too small. If this in the case, the tissue is pulled through the unprotected abdominal wall and may contaminate the latter.
It is not rare that the pulling forces exerted upon the tissue during extraction cause destruction of parts of the tissue, and during this process infective materials, tissue particles, malign cell formations or calculi may get into the free abdominal space.
Inflammatory, swollen organ tissue or big calculi, and their summation effects, may render the extraction impossible mechanically.
Consequently, techniques and instruments have been developed by means of which organ tissue can be disintegrated intra-abdominally, for example in the case of hysteromyoma. While mechanical and ultrasonic crushing of calculi can be employed in an intact gallbladder, their use in the free abdominal space, for crushing big calculi is not possible.
However, it is a necessity with all laparoscopic methods that tissue above a given maximum size must be reduced in size intra-abdominally by puncture, crushing, or mechanical destruction, before it can be extracted from the abdominal space because increasing the incision in the abdominal wall would be contrary to the very idea underlying the laparoscopic operation method. Crushing tissue intra-abdominally increases, however, the risk of infection in the abdominal space.
If an enlargement of the incision in the abdominal wall still becomes necessary during a laparoscopic operation, this is likewise in contradiction to the basic idea of least-invasive surgery, provides the risk of hemorrhage, of subsequent herniation, and requires the abdominal wall to be sutured by layers.
From the before-mentioned publication, a plastic pouch has been known in which the removed material can be crushed while still within the patient's body. One also developed a special crushing tool for this purpose.
The known plastic pouch and the instruments used in combination with it do not provide sufficient protection from the increased risk of contamination in laparoscopic operations inherent in this method. During removal and/or during intra-abdominal crushing of the tissue or calculi, infective or malign material may drip back into the abdominal wall and the abdominal space along the outside of the container.
There has been further known a big-caliber instrument by Kiaiber for extracting big calculi from the free abdominal space while preserving the pneumoperitoneum. However, this instrument also provides the risk that during removal of the tissue infective or malign material may drip back into the abdominal space from the trocar sleeve.